Anorexia Nervosa: Psychological Mechanisms and Treatment Review

This literature review explores Anorexia Nervosa, a severe mental illness characterized by restricted food intake, fear of weight gain, and distorted body image. It delves into the psychological mechanisms underlying the disorder, including distorted beliefs about body weight and shape, and the co-occurrence of depressive and anxiety symptoms stemming from poor nutritional status and its impact on serotonin levels. The review examines various treatment approaches, including psychotherapy, family approaches, nutritional management, and medication, highlighting the importance of professional help, accurate diagnosis, and a combination of therapies. Factors influencing recovery, such as support from family and healthcare professionals, treatment suitability, and addressing underlying factors, are also discussed. The review further explores the association between Anorexia Nervosa and mental complications such as anxiety disorders, obsessive-compulsive disorder and the physical impact of the illness on the body. References from various research papers are provided to support the findings and provide further context.

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Literature Review
Anorexia and the underlying psychological mechanism
According to David (2011), AN is a severe mental illness that is characterize via
decrease in the intake of food along with an escalating fear of weight gain and skewed
perception about the body image. David (2011) has further opined that the main pillar of such
mental perceptions is generally distorted beliefs in relation to body weight, body shape and
image of the body. Though the majority of the literature of eating disorders have highlight
such beliefs to be overvalued ideas (OIs) which are unreasonable and sustained beliefs
nurtured with less delusional intensity, the latest quantitative research is of the opinion that
background of such beliefs might have certain delusional qualities (Hartmann et al., 2013).
According to O'Connell et al. (2017) OIs are distinct from delusions as an individuals are
able recognize their beliefs are inaccurate. The research conducted by Hartmann et al. (2013)
highlighted that the depressive symptoms along with obsessive symptoms and anxiety co-
occur with AN. This depressive and anxiety symptoms have a psychological perspectives.
According to Gauthier et al. (2014), depression and anxiety in case of the patients suffering
from An mainly stems from the poor nutritional status and its subsequent impact on the
serotonin markers and whole blood serotonin content. This disruption in the equilibrium of
the serotonin reuptake receptors leads to the increase in the depressive symptoms among the
patients suffering from AN thereby making the disease progression worse along with
infiltration of the delusional thoughts. Similar findings have been highlighted by the study
conducted by Mattar et al. (2012). Mattar et al. (2012) is of the opinion that the clinical
consensus behind the depressive symptoms and anxiety is a squeal of malnutrition among the
AN patients. Mattar et al. (2012) further opined that poor nutritional content lead to the
decrease in the BMI among the patients suffering from AN and these leads to high

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psychometric scores which signifies high level of depressive symptoms among the patients
with AN.
Treating eating disorders
It has been widely discussed in literature that eating disorders are associated with
psychiatric symptoms as well as physical symptoms that are related to distinct medical
complications. Existing reports indicate that general utilization of healthcare services among
this section of the patient population is high. There exist distinct indicators of elevated health
service utilization among those with eating disorders. The economic burden and health
service use of eating disorders entail immediate attention as data estimates the implications of
the health condition to be having huge health care resource requirements. The economic
burden of the disease is substantial, and there is a need of identifying the suitable cost-
effective treatment options (Lock & Le Grange, 2015).
People suffering from eating disorders require professional help at some point in time
for recovering back to a normal life course. An accurate diagnosis is the crucial step toward
recovery from the eating disorder. Treatment in healthcare systems encompasses a wide
range of treatment options involving combination of nutritional counseling and psychological
counseling. Medical monitoring aids in this regard, as opined by Zipfel et al., (2015).
Healthcare units address the symptoms of the patient as well as the medical consequences,
together with the cultural, interpersonal, biological and psychological forces contributing to
eating disorder. It is to be mentioned in this regard that support from family and parents is
crucial for recovery, and healthcare professionals work in collaboration with the family
members to assist in the best possible form of care. The first point of care for a patient with
eating disorder is to establish a rapport with the individual that fosters a therapeutic
relationship between the patient and care giver. Starting the conversation can be the toughest

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part for care delivery and therefore it is important to understand the behaviors, thoughts,
feelings and perceptions of the individuals.
Madden et al., (2015) reviewed the best treatment approaches for addressing eating
disorders in healthcare system. These evidence-based approaches are not stand-alone options;
rather they might be required to be delivered in adjunct with each other. Psychotherapy,
family approaches, self-help approaches, nutritional management and medication. Lock et al.,
(2015) analyzed that psychotherapy is the best possible intervention for treating eating
disorder as the focus is on the patient’s motivations, patterns of thinking, relationships and
behaviors. Models such as Cognitive Analytic Therapy, Cognitive Behavioural Therapy
(CBT) and Dialectical Behavioural Therapy (DBT) have been proved to be effective in this
regard. Family approaches are common when patients are adolescents and support network is
essential for recovery. Self-help treatments are known to be effective when they are applied
in combination with other treatment approaches.
Health care systems also focus on nutritional management and medication
management for treating patients with eating disorders. A dietician or nutritionist is
responsible for outlining the nutritional management regime. The approach ensures that the
client receives the required level of nutritional support in the form of minerals and vitamins
that is helpful for development of beneficial and normal eating behaviors and habits.
Medication-based interventional approaches are vital when the client is suffering from a co-
morbid condition, such as psychosis, insomnia and anxiety (Link et al., 2017).
Factors that eating disorder sufferers identify as contributing to their recovery
Eating disorders such as anorexia nervosa has been characterized by restraints of
energy intake, severe disturbances and fear of gaining weight. Recovery from the condition
is known to be a highly complex process, wherein patients undergo multifaceted experiences.

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The experiences of the treatment are linked with effectiveness of the recovery process, as the
same enhances or hinders recovery. A number of factors have been identified that can benefit
or hinder recovery process. These factors can be understood as support provided to the
patient with eating disorder, treatment suitability and treatment of underlying factors
(Dawson et al., 2014).
Aardoom et al., (2014) opined that patients with eating disorders are able to recover
from their condition when they receive optimal support from their near ones, as well as the
healthcare professionals. Lack of social support on the other hand is responsible for
disempowering individuals, thereby hindering the process of recovery. The elements of
support are hopefulness, empowerment, active listening, and increased feeling of self-worth
and learning new coping mechanisms. When patients feel unsafe or undeserving, their
recovery process is impaired. Strober and Johnson (2012) in this regard highlighted that
imbuing hope through support can make patients feel valued, augmenting their motivation to
recover. Feeling listened to and worthy enables individuals to open up and embrace changes.
Patients have often reported that when they are made to feel more confident and stronger,
there is an urge to control their lives and claim the fundamental rights. Research indicates that
when the patients are adolescents, a positive and supportive relationship with the parents is
noteworthy in achieving recovery. This underscores the importance of parent involvement in
therapies for eating disorders.
Fogarty and Ramjan (2016) studied the factors enabling recovery in eating disorder
patient and commented that relationship with the healthcare provided influenced to a great
extent the process of recovery through motivation or demotivation. Patients have reported in
a number of studies that they feel self-satisfaction when the care providers praise them for the
small yet significant achievements they make in the recovery process. When the input of the
patients are valued and given consideration in the treatment process, there is a push for

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abiding by the treatment regimen. This brings in the concept of patient involvement in care
process. As a person with illness, patients of eating disorders require warmth and affection to
heal and come in terms with the present condition. Improved self-esteem leads to increase in
confidence and ability to cope up with the body needs. When suffering from eating disorders
such as anorexia, self control is necessary and only comfortable environment can ensure that
self-control is permitted.
At the end, a discussion is also to be put up regarding the treatment suitability in
recovery process. Patients have pointed out in the past that individualized, compassionate and
systematic care is only fruitful for proper recovery of the patient. Individuals have
experienced treatment providers as conveying empathy, patience and a genuine belief in their
worth as a human being (Ramjan & Gill, 2012).
Anorexia Nervosa, and mental complications
Eating disorders like anorexia nervosa are serious and are regarded as potentially life-
threatening conditions that affect both physical health and emotional wellbeing (). According
to the reports published by Hildebrandt et al. (2012), anxiety disorders and anorexia nervosa
shares common temperamental elements which leads to specific personality characteristics.
Hildebrandt et al. (2012) cited an example that temperamental characteristics of
perfectionism, compulsivity, harm avoidance, rigidity and trait of anxiety are elevated among
the population who are diagnosed with anorexia nervosa. Bazhan and Zelena (2013) have
also identified stress as the leading factor behind the development of anorexia nervosa.
According to Bazhan and Zelena (2013), anxious temperament and perfectionist attitude is
common among the population of anorexia nervosa. This manifestoes in unrelenting
standards for thinners, intolerance towards mistakes or defects and often provides a
catastrophic view regarding how behaviours like under-eating or fear or eating and weight

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gain is related with the current stated of interpersonal behaviour. According to Brytek-Matera
(2012), anorexia nervosa shares highest level of comorbidity with obsessive-compulsive
disorder and social phobia arising out of social exclusion. This pattern of comorbidity among
the population with anorexia nervosa suggests the possible genetic heritability of numerous
traits that contribute towards anxiety. Brytek-Matera (2012), further stated that anxiety is
undoubtedly the central psychological features of anorexia nervosa. This manifests mainly in
response to food, eating, social evaluation, physical appearance and shape and interoceptive
cues. Boraska et al. (2014), is of the opinion that eating disorders like anorexia nervosa which
deals with dangerously low consumption of calories affect every and every organ and organ
system of the body. According to Boraska et al. (2014), consuming less than required calories
signifies that the body breaks down its own tissue in order to use it as fuel. Muscle is the first
organ that is being broken down and this results in muscle wasting and subsequent generation
of fatigue. Boraska et al. (2014), opined that heart is an important muscle of the heart and
wasting of the muscle also effects the heart and as a consequence of this, there occur sudden
drop in blood pressure. The risk of heart failure arises as the heart rate decreases significantly
along with decrease in oxygen supply in the body. Apart from the cardiovascular threat,
anorexia nervosa or decreased eating is also associated with the development of gastro-
intestinal complications like pain in stomach, bloating, nausea, vomiting, and constipation
and high-level of acidity arising out of empty stomach. According to Boraska et al. (2014),
anorexia nervosa is associated with neurological anomalies. This because, decrease in the
amount of food consumption results in decrease aunt of ATP in the body. As a result brain
fails to receive adequate ATP resulting in defects in the neuro-transmitter and problem in the
neuronal impulses. In severe consequences, if the blood vessels directed towards the brain,
fail to push adequate blood, it results in fainting, dizziness and the individuals experience

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sever difficulty in standing upright. This increase in dizziness is linked with sever fatigue
with is common among the individuals suffering from norexia nervosa (Boraska et al., 2014).

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References
Aardoom, J. J., Dingemans, A. E., Boogaard, L. H., & Van Furth, E. F. (2014). Internet and
patient empowerment in individuals with symptoms of an eating disorder: A cross-
sectional investigation of a pro-recovery focused e-community. Eating
behaviors, 15(3), 350-356.
Bazhan, N., & Zelena, D. (2013). Food-intake regulation during stress by the hypothalamo-
pituitary-adrenal axis. Brain research bulletin, 95, 46-53.
Boraska, V., Franklin, C. S., Floyd, J. A., Thornton, L. M., Huckins, L. M., Southam, L., ... &
Lewis, C. M. (2014). A genome-wide association study of anorexia
nervosa. Molecular psychiatry, 19(10), 1085.
Brytek-Matera, A. (2012). Orthorexia nervosa–an eating disorder, obsessive-compulsive
disorder or disturbed eating habit. Archives of Psychiatry and psychotherapy, 1(1),
55-60.
Dawson, L., Rhodes, P., & Touyz, S. (2014). “Doing the Impossible” The Process of
Recovery From Chronic Anorexia Nervosa. Qualitative health research, 24(4), 494-
505.
Fogarty, S., & Ramjan, L. M. (2016). Factors impacting treatment and recovery in Anorexia
Nervosa: qualitative findings from an online questionnaire. Journal of eating
disorders, 4(1), 18.
Gauthier, C., Hassler, C., Mattar, L., Launay, J. M., Callebert, J., Steiger, H., ... & Lang, F.
(2014). Symptoms of depression and anxiety in anorexia nervosa: Links with plasma
tryptophan and serotonin metabolism. Psychoneuroendocrinology, 39, 170-178.

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Hartmann, A. S., Thomas, J. J., Wilson, A. C., & Wilhelm, S. (2013). Insight impairment in
body image disorders: Delusionality and overvalued ideas in anorexia nervosa versus
body dysmorphic disorder. Psychiatry Research, 210(3), 1129–1135.
https://doi.org/10.1016/j.psychres.2013.08.010
Hildebrandt, T., Bacow, T., Markella, M., & Loeb, K. L. (2012). Anxiety in anorexia nervosa
and its management using family‐based treatment. European Eating Disorders
Review, 20(1).
Link, T. M., Beermann, U., Mestel, R., & Gander, M. (2017). Treatment Outcome in Female
In-Patients with Anorexia nervosa and Comorbid Personality Disorders Prevalence-
Therapy Drop out and Weight Gain. Psychotherapie, Psychosomatik, medizinische
Psychologie, 67(9-10), 420-430.
Lock, J., & Le Grange, D. (2015). Treatment manual for anorexia nervosa: A family-based
approach. Guilford Publications.
Lock, J., Le Grange, D., Agras, W. S., Fitzpatrick, K. K., Jo, B., Accurso, E., ... & Stainer, M.
(2015). Can adaptive treatment improve outcomes in family-based therapy for
adolescents with anorexia nervosa? Feasibility and treatment effects of a multi-site
treatment study. Behaviour research and therapy, 73, 90-95.
Madden, S., Miskovic-Wheatley, J., Wallis, A., Kohn, M., Lock, J., Le Grange, D., ... &
Touyz, S. (2015). A randomized controlled trial of in-patient treatment for anorexia
nervosa in medically unstable adolescents. Psychological medicine, 45(2), 415-427.
Mattar, L., Thiébaud, M. R., Huas, C., Cebula, C., & Godart, N. (2012). Depression, anxiety
and obsessive–compulsive symptoms in relation to nutritional status and outcome in
severe anorexia nervosa. Psychiatry research, 200(2), 513-517.

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O'Connell, J. E., Bendall, S., Morley, E., Huang, C., & Krug, I. (2017). Delusion‐like beliefs
in anorexia nervosa: An interpretative phenomenological analysis. Clinical
Psychologist
Ramjan, L. M., & Gill, B. I. (2012). An inpatient program for adolescents with anorexia
experienced as a metaphoric prison. AJN The American Journal of Nursing, 112(8),
24-33.
Strober, M., & Johnson, C. (2012). The need for complex ideas in anorexia nervosa: why
biology, environment, and psyche all matter, why therapists make mistakes, and why
clinical benchmarks are needed for managing weight correction. International Journal
of Eating Disorders, 45(2), 155-178.
Zipfel, S., Giel, K. E., Bulik, C. M., Hay, P., & Schmidt, U. (2015). Anorexia nervosa:
aetiology, assessment, and treatment. The Lancet Psychiatry, 2(12), 1099-1111.